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We are what we eat, but we pay no attention

May 9, 2022 | 04:27 pm PT
Quan The Dan Doctor
City folks are dealing with obesity and their rural counterparts with its opposite. Both are forms of malnourishment that do not receive sufficient attention.

I've attended to many patients with severe conditions in lower-level hospitals. Their diseases are one thing, but the situation is further exacerbated by the fact that many suffer from severe malnutrition.

There was an 87-year-old who was recently hospitalized for her heart condition. She was also severely malnourished. She weighed just 26kg when she was hospitalized and her body showed clear signs of dehydration. I requested that her family make her drink more milk. Though she was not used to it, she decided to follow the doctor's order. In a week, her weight jumped to 30 kg and the day she was discharged, she ate two bowls of rice by herself.

A 2016 study by HCMC's Thong Nhat Hospital found 65 percent of elderly patients in hospitals suffering from malnutrition. One is considered to be malnourished if 5-10 percent of their weight is lost within six months to a year.

Nutrition is an important aspect of life, but not many people actively seek out information about it. The daily energy demand for an average person is around 3-4 kcal/kg, meaning a person who weighs 50 kg would need around 1,000-2,000 kcal a day. More specifically, they would need around 225g of carbohydrates, 42g of lipid and 60g of protein.

But these are just simple numbers. To see exactly how much nutrients our food contains, we need to look it up. A typical bowl of rice would have 130 kcal and three bowls of porridge would equal a bowl of rice. A bowl of instant noodles would have 190 kcal, while a small loaf of bread would have 30 kcal, the same as a banana.

By looking up how much nutrients are packed in units of food, we can get a glimpse into why people with diseases are often malnourished as well. Many a time, it happens because they simply can't eat. How can a person who weighs only 50kg eat 7-8 bowls of rice and 300 grams of meat a day? If only porridge was consumed in place of rice, some people might require at least 20 bowls a day, which is a nightmare.

Elderly people often lose their appetite when they fall sick. Sometimes, they get only around 100 kcal a day, which is a tenth of the recommended intake. It would only take around 10 days of such consumption before they suffer from severe malnutrition.

So far, I have not even mentioned micronutrients like potassium, sodium, magnesium and vitamins. That is why we need nutritionists to do the math. Those with special nutrition needs, for example people with particular diseases, those who require tube feeding or people in a coma would need specialists like doctors, nurses and nutritionists to take care of them.

Nutrition departments in hospitals specialize in crafting diets for people. Most hospitals in major cities have them. However, their function remains limited as they often do not receive adequate attention. In several lower-level hospitals, nutrient departments have been disbanded for lack of funds. This means patients receive no dietary guidance from experts, leading to more problems.

If someone is sick, it is common for family members and acquaintances to chime in on what they should eat or drink. But not all such advice is good; a diet that has not been well-calibrated may cause foods to clash with each other, leading to indigestion or worse.

There are safe choices: soups and milk are generally great. If they are properly made, patients could get 1 kcal/ml out of them. With just six small meals a day, each with 300 cal, a person can get 1,800 kcal a day, enough to meet energy and nutrient demands.

A balanced diet with needed nutrients can be a huge step forward in improving our health – individually and as a community. It's not all that difficult to make it part of our daily life.

Both healthcare experts and lay persons should appreciate this and pay more attention to nutrition – within and outside hospitals.

*Quan The Dan is a doctor who is now deputy director of Tri Duc Thanh General Hospital in Thanh Hoa Province in central Vietnam. The opinions expressed are his own.

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